Surgical ventricular entry impact in primary glioblastoma - leptomeningeal disease and survival: a Systematic Review with Meta Analysis.

Abstract

Objective: This systematic review aims to ascertain whether ventricular entry (VE) during surgical resection of primary glioblastoma (GBM) is related to higher odds of leptomeningeal dissemination (LMD) and its influence on survival. Other complications (hydrocephalus, cerebral spinal fluid fistulas, wound infection and distant recurrences) were assessed as secondary outcomes. Methods: Studies included adult primary GBM patients classified according to the occurrence of ventricular entry (VE) or not (non-VE) during first surgical resection, with data on our outcomes of interest. Three electronic scientific databases (PubMED, SCOPUS and WebOfScience) were searched on February 2024 for "(Ventric* entry OR ventric* opening OR ventriculostomy) AND (glioblastoma OR GBM)". 7 studies met our criteria for a total of 1225 patients, all retrospective cohorts. Data on our outcomes of interest were collected. A meta-analysis was conducted for overall survival (OS) (n=1114) and progress free survival (PFS) (n=791), using the generic inverse-variance model with random-effects analysis from Cochrane's Review Manager tool. Results: Our overall effect estimate for OS was hazard ratio (HR) 1.09 (95% CI 0.79-1.53), p=0.59, but as statistical heterogeneity between studies is considered high (I2 >75%) we should not draw conclusions from this estimate. We obtained an overall effect estimate of HR 0.85 (95% CI 0.65-1.11), p=0.23 for PSF, which was not affected by VE. Synthesis of results was not obtained for leptomeningeal dissemination (LMD), hydrocephalus, distant recurrence or other complications, as published data were insufficient. Discussion: This meta-analysis did not reveal a negative impact of VE on survival in an overall cohort of primary GBM patients. No conclusions can be drawn regarding the impact of VE on the incidence of LMD. Data on other complications are scarce. We present valuable insights on information and data that should be systematically reported in future GBM research to clarify remaining uncertainties.